Cytokine Storm
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2021 ◽  
Vol 12 (12) ◽  
pp. 23-31
Mukesh Kumar ◽  
CM Bindu ◽  
AC Shyam ◽  
R Reena

Background: Diabetics exhibit elevated serum ferritin level when compared to non-diabetic counterpart, indicates impact of its association with coronavirus disease 2019 (COVID-19) infection and disease progression. Ferritin is a key mediator of immune dysregulation through direct immunosuppression contributing to cytokine storm resulting in fatal outcome in COVID-19. Aims and Objectives: This study aims to estimate serum ferritin in diabetic (cases) and non-diabetic (controls) COVID-19 patients and its correlation with their diabetic profile (FBS, PPBS, RBS, and HbA1C). Materials and Methods: A retrospective case–control study conducted at Rajarajeswari Medical College and Hospital, Bengaluru, for a period of 8 months among diabetic and non-diabetic COVID-19 patients. Results: The study population consisted of 957 individuals, out of them, 425 patients were type 2 diabetes mellitus and 532 were non-diabetic COVID-19-positive patients (controls). Diabetic profile parameters (FBS, PPBS, RBS, and HbA1c) and serum ferritin were significantly (P<0.05) high in cases as compared to controls. Among diabetic COVID-19, the glycated hemoglobin and serum ferritin showed a significantly positive correlation (r=0.55) with serum ferritin (mean=648.98±320.48). Conclusion: Hyperferritinemia is more prevalent in diabetic COVID-19 individuals. Serum ferritin can be considered as a valuable biomarker to screen the diabetic and non-diabetic for the presence of hyperinflammation and to predict severity of COVID-19 infection so that it will help the clinician for proper management.

2021 ◽  
pp. 148-152
E. V. Popova

The need to review the guidelines for the management of patients with multiple sclerosis using multiple sclerosis disease modifying drugs has become acute enough since the beginning of 2020 following the outbreak of the COVID-19 pandemic caused by a novel coronavirus SARS-CoV-2. Immunosuppressive drugs were also specifically addressed, as it is during administration of these drugs that the more severe course of COVID-19 disease was expected. Both the Russian and foreign teams published results of their research works. This article presents a retrospective analysis of the incidence rates of COVID-19 in patients with multiple sclerosis after selective immunosuppressive therapy with alemtuzumab and a clinical case when a patient was infected with coronavirus in the first days following the last infusion of the therapy course without clinical manifestations of the infectious disease. The author discusses the mechanisms underlying such a favourable outcome due to the CD52 lymphocyte depletion leading to the reduction of risks of developing hyperimmune reactions that underlie severe complications of COVID-19, and analyses previously published works of our foreign colleagues on the same theme. The review of the accumulated works and personal experience suggest that it is the CD52 lymphocyte depletion that makes it possible to avoid the cytokine storm and, as a result, the more severe course of COVID-19. Amidst the COVID-19 pandemic, during the prescription of multiple sclerosis disease modifying drugs, it should be borne in mind that patients should have access to all types of modern therapy and that the benefits should outweigh the sum of possible risks.

2021 ◽  
Vol 22 (23) ◽  
pp. 13009
Xi-Dian Tang ◽  
Tian-Tian Ji ◽  
Jia-Rui Dong ◽  
Hao Feng ◽  
Feng-Qiang Chen ◽  

Cytokine storm is a phenomenon characterized by strong elevated circulating cytokines that most often occur after an overreactive immune system is activated by an acute systemic infection. A variety of cells participate in cytokine storm induction and progression, with profiles of cytokines released during cytokine storm varying from disease to disease. This review focuses on pathophysiological mechanisms underlying cytokine storm induction and progression induced by pathogenic invasive infectious diseases. Strategies for targeted treatment of various types of infection-induced cytokine storms are described from both host and pathogen perspectives. In summary, current studies indicate that cytokine storm-targeted therapies can effectively alleviate tissue damage while promoting the clearance of invading pathogens. Based on this premise, “multi-omics” immune system profiling should facilitate the development of more effective therapeutic strategies to alleviate cytokine storms caused by various diseases.

2021 ◽  
James R Michels ◽  
Mohammad Shaheed Nazrul ◽  
Sudeep Adhikari ◽  
Dawn Wilkins ◽  
Ana B Pavel

A predominant source of complication in SARS-CoV-2 patients arises from the cytokine storm, an elevated expression of inflammatory helper T-cell associated cytokines that can lead to tissue damage and organ failure. The high inflammatory burden of this viral infection often results in cardiovascular comorbidities. A better understanding of the interaction between the cytokine storm and cardiovascular proteins might inform medical decisions and therapeutic approaches. We hypothesized that all major helper T-cell inflammatory pathways (Th1, Th2 and Th17) synergistically contribute to cardiometabolic modifications in serum of COVID-19 patients. We proved our hypothesis by integrating Th1, Th2 and Th17 cytokines to predict expression of cardiometabolic proteins profiled by OLINK proteomics.

2021 ◽  
Vol 10 (23) ◽  
pp. 5599
Jose L. Francisco Santos ◽  
Patricio Zanardi ◽  
Veronica Alo ◽  
Marcelo Rodriguez ◽  
Federico Magdaleno ◽  

In COVID-19, pulmonary edema has been attributed to “cytokine storm”. However, it is known that SARS-CoV2 promotes angiotensin-converting enzyme 2 deficit, increases angiotensin II, and this triggers volume overload. Our report is based on COVID-19 patients with tomographic evidence of pulmonary edema and volume overload to whom established a standard treatment with diuretic (furosemide) guided by objectives: Negative Fluid Balance (NEGBAL approach). Retrospective observational study. We reviewed data from medical records: demographic, clinical, laboratory, blood gas, and chest tomography (CT) before and while undergoing NEGBAL, from 20 critically ill patients. Once the NEGBAL strategy was started, no patient required mechanical ventilation. All cases reverted to respiratory failure with NEGBAL, but subsequently two patients died from sepsis and acute myocardial infarction (AMI). The regressive analysis between PaO2/FiO2BAL and NEGBAL demonstrated correlation (p < 0.032). The results comparing the Pao2Fio2 between admission to NEGBAL to NEGBAL day 4, were statistically significant (p < 0.001). We noted between admission to NEGBAL and day 4 improvement in CT score (p < 0.001), decrease in the superior vena cava diameter (p < 0.001) and the decrease of cardiac axis (p < 0.001). Though our study has several limitations, we believe the promising results encourage further investigation of this different pathophysiological approach.

2021 ◽  
Vol 14 (12) ◽  
pp. 1236
Aussara Panya ◽  
Kanyaluck Jantakee ◽  
Suthida Punwong ◽  
Supawadee Thongyim ◽  
Thida Kaewkod ◽  

Traditional Triphala (three fruits), consisting of Phyllanthus emblica, Terminalia chebula, and Terminalia bellirica, presents a broad range of biological activities. However, its ability to inhibit dengue virus (DENV) infection has not been reported yet. Herein, the authors investigated the efficiency of three different Triphala formulations and its individual extract constituents to inhibit DENV infection. Treatment with T. bellirica extract or Triphala formulated with a high ratio of T. bellirica extract showed remarkable efficiency in significantly lowering DENV infection in Vero cells. Their effects were further studied in Huh7 cells, to address its potential ability in human cells. Treatment with 100 μg/mL of T. bellirica extract or Triphala resulted in an approximate 3000-fold or 1000-fold lowering of virus production, respectively. Furthermore, the treatment diminished IL-6 and CXCL-10 expressions, which are the hallmark of the cytokine storm phenomenon in DENV infection. The HPLC profiling demonstrated gallic acid as a major compound, the treatment by which showed its ability to effectively inhibit DENV infection after virus entry. Molecular docking demonstrated that gallic acid was able to interact with DENV NS5 protein, which could be one of Triphala’s antiviral mechanism. This study offers Triphala formulation and its ingredient, T. bellirica extract, as a natural based pharmaceutical to be used in DENV infection treatment.

Nadeem Siddiqui ◽  
Shaik Mohammad Anjum ◽  
Sreeja Nannapaneni ◽  
Sri Sarvani Vemuri ◽  
Bhavana Potluri ◽  

Recent examinations express that multi organ failure is seen in Corona virus infected patients with different pathway. It has been shown in contemplates that increased levels of cytokines like IL-1B and INF gamma were observed. It is called as cytokine storm with higher convergences of CCL2 and CXCL10. The cytokine storm is trailed by our immune system attacking own body which thus may cause numerous organ abnormalities and conclusive outcome being death. There is currently no specific treatment for viral illness, and this methodology is an optional path for focusing on specific qualities that may diminish cytokine storm. In such manner Peroxisome Proliferators Activated Receptors (PPARs) have a place with group of transcription factors which are known to manage the inflammatory mechanisms in body. This immunomodulatory approach is intended to focus PPAR-gamma ligands and their molecular docking studies. The activation or increased expression levels of PPAR gamma because of chosen agonists may reduce the cytokine storm in the covid patients. Thus, this is one such fascinating way to deal with neutralization of the cytokines exorbitantly elevated by use of substances like pomegranate, lemon grass and so on to activate PPARs reliably.

2021 ◽  
Vol 22 (23) ◽  
pp. 12786
Thomas Köhler ◽  
Elke Schwier ◽  
Janina Praxenthaler ◽  
Carmen Kirchner ◽  
Dietrich Henzler ◽  

The “normal” immune response to an insult triggers a highly regulated response determined by the interaction of various immunocompetent cells with pro- and anti-inflammatory cytokines. Under pathologic conditions, the massive elevation of cytokine levels (“cytokine storm”) could not be controlled until the recent development of hemoadsorption devices that are able to extract a variety of different DAMPs, PAMPs, and metabolic products from the blood. CytoSorb® has been approved for adjunctive sepsis therapy since 2011. This review aims to summarize theoretical knowledge, in vitro results, and clinical findings to provide the clinician with pragmatic guidance for daily practice. English-language and peer-reviewed literature identified by a selective literature search in PubMed and published between January 2016 and May 2021 was included. Hemoadsorption can be used successfully as adjunct to a complex therapeutic regimen for various conditions. To the contrary, this nonspecific intervention may potentially worsen patient outcomes in complex immunological processes. CytoSorb® therapy appears to be safe and useful in various diseases (e.g., rhabdomyolysis, liver failure, or intoxications) as well as in septic shock or cytokine release syndrome, although a conclusive assessment of treatment benefit is not possible and no survival benefit has yet been demonstrated in randomized controlled trials.

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Xun Li ◽  
Mengchao Yan ◽  
Jun Chen ◽  
Yang Luo

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has seriously affected public health and social stability. The main route of the transmission is droplet transmission, where the oral cavity is the most important entry point to the body. Due to both the direct harmful effects of SARS-CoV-2 and disordered immune responses, some COVID-19 patients may progress to acute respiratory distress syndrome or even multiple organ failure. Genetic variants of SARS-CoV-2 have been emerging and circulating around the world. Currently, there is no internationally approved precise treatment for COVID-19. Mesenchymal stem cells (MSCs) can traffic and migrate towards the affected tissue, regulate both the innate and acquired immune systems, and participate in the process of healing. Here, we will discuss and investigate the mechanisms of immune disorder in COVID-19 and the therapeutic activity of MSCs, in particular human gingiva mesenchymal stem cells.

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